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APPLICATION FOR SANITATION'PERMIT Permit No. -- --------- --------- t? � ,. (Complete in Duplicate) Date Issued ------3 :S---n---- Application is hereby made to the San Joaquin Local Health District for a permit-toconstruct and install the work herein described. This application is made in compliance with County Ordinance No, 549. JOB ADDRESS AND LOCATION A.3%T_ ax .— ---------- A �---------------••------•------------------- IOwner's Name--------- -----_ -kegc_�-------- .......... ��T`ZJ-�-------------s--------- -------------------- ------------------------- Phone---------------------------------------- � ` Address------------------------- y' /P e ContractorsName----------------------C�-- - -- - -- - ----------------------- -------------------------------------- :------------------ Phone----------------------------------- Installation .-----•-------•--••_---•---- ----Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---------Number of bedrooms -------- Number of baths -------- Lot size------------------------------------------------------------- t Water Supply: Public system ❑ Community system ❑ 'Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet:. Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ f Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank orcesspool pe`rktted if public sewer is available within 200 feet.) ' Septic ank: Distance from nearest well___-,�".---Distance from founds 'on'_/_0--_----Material----n_,4_1r No. of compartments......�----------------Size-_,:�J--- � -- -t iquid dep��4-_K__F_X_A_V_Capacity.___1---6_C� Dispos I Field: Distance from nearest well----_,S'-o_____-Distance from fours ation-------/_1t----___.Distance to nearest lot line_-.,._ Length of each line---- ----.Width of trench.---------2#-_'.�-__._-.------- Number of_lines: ?------------------- - -_._ 5 rt - .�. ,•..� it � -`Type of filter m'ateriaL__ �G, -Depth offilter material-----/-$-____-_-__-Total length-----_---/-a-&-0----I-_ ---- Seepa�e Pit: "Distance to-nearest well:__'%_Ck-_.-p--.---'Distance from foundation-----1-40--------. ista to nearest lot line___--_-.-- �r r` Dt Number of pits-_---��._'-_____Lining material-----/��-��/_-Size: Diameter--_� Cesspool• Distance from nearest well----------------- from .foundation-=-----.----._----..Li infi_�ie ------ ----- galp h =- Liqu , V- Privy: Distance from nearest well------------------ --- --------------._Distance from nearest building ------ Size: Diameter --------- ---- --------- ❑ - - � Distance to nearest lot line- '--------------------------------------- --•------------------- - -------------------------- ---_---------------•------------ - -- - Remodeling and/or repairing (describe]:---'_-_( ,8Y �---,� - ---,�t+ t ----------------- ------------------------ ---------------- --- --------------------------•------------------------------------------------__---------- --------------------------------------------- - ----------------------- --------------------------------------------•---------------------------------G l I hereby certify that I have prepared this application and that the work will be douj r cordance with San Joaquin County, ordinances, S to laws, and rules d regulations of the San Joaquin Loc ealth DistriEf (5igned�- -,-------------- -- ---------'� (Owner and/or Contractor) s ----------------•----•--------------------------------------------------------------------------------------------- (Title) (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------;-------- ----------•---- ----------------- -}---------------------------------- -- DATE--------------------------- REVIEWEDBY--------------------------------------------- - ---------------N----------- _:------------ ----- DATE__--------------- /_ BUILDING PERMIT ISSUED------------- - ------------------------ DATE-------------------- ----- --- -------------------------------------- Aiterations and/or recommendations: - -- -- ------------------------.- ---------------•--------------------•-•----------- ------- -- ---- f�----a7----------3' � -- -- -- It-as � ,"Y1[� O ----- .....ox--------- ----------- ---- - - - a----.o- ---- ---- --- ---------- i s -� u. �1Q-.�..on----- -t Q: u� 5e--------- -0,1 41Y4 �v0 py A -res i,Vs�'. FINAL INSPECTION BYi-...--- ------------------------------ ------- - ---------- Date------------ -------- SAN -SAN JOAQUIN LOCAL HEALTH DISTRICT ` 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California w( 1� E5-9-2M Revised 1.57 F.P,GO.